Marcus Mitchell Fuller, LAC , LMT, MACOM
Individual provider Active NPI Acupuncturist · Bozeman, MT
NPI 1780157040 · NPPES record last updated Jan 9, 2019
Key facts
- NPI
- 1780157040
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Acupuncturist 171100000X
- License
- MED-ACU-LIC-70143 (MT)
- Practice address
- 300 N Willson Ave Ste 2003
Bozeman, MT 59715-3597 - Phone
- (406) 577-2168
- NPI assigned
- Jan 9, 2019
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 138929 | AK | MD | Acupuncturist |
| MED-ACU-LIC-70143 | MT | MD | Acupuncturist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ambulant Acupuncture LLC | Acupuncturist | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Acupuncturist | 171100000X | 138929 | AK | |
| Acupuncturist | 171100000X | MED-ACU-LIC-70143 | MT | Yes |
Addresses
Primary practice location
300 N Willson Ave Ste 2003
Bozeman, MT 59715-3597
Mailing address
PO Box 3205
Valdez, AK 99686-3205
Phone (907) 255-8413
Other providers in Bozeman, MT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 9, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.